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To improve preparedness for natural disasters, it is imperative to understand the factors that enable individual risk-reduction actions. This study offers such insights using innovative real-time (N = 871) and repeated (N = 255) surveys of a sample of coastal residents in Florida regarding flood preparations and their drivers during an imminent threat posed by Hurricane Dorian and its aftermath. Compared with commonly employed cross-sectional surveys, our methodology better represents relationships between preparedness actions undertaken during the disaster threat and their drivers derived from an extended version of Protection Motivation Theory (PMT). The repeated survey allows for examining temporal dynamics in these drivers. Our results confirm the importance of coping appraisals and show that risk perceptions relate more strongly to emergency protection decisions made during the period of the disaster threat than to decisions made well before. Moreover, we find that several personal characteristics that we add to the standard PMT framework significantly relate to undertaking preparedness actions, especially locus of control and social norms. Significant changes in key explanatory variables occur following the disaster threat, including a decline in risk perception, a potential learning effect in coping appraisals, and a decline in risk aversion. Our results confirm the advantage of the real-time and repeated survey approach in understanding both short- and long-term disaster preparedness actions., (© 2024 The Authors. Risk Analysis published by Wiley Periodicals LLC on behalf of Society for Risk Analysis.)

Background: Hurricane Harvey was the second costliest storm to impact the U.S. More research is needed to understand the mental health consequences of these extreme events in children and adolescents extending beyond the acute recovery period., Methods: Daily anonymized Crisis Text Line (CTL) conversations were used to understand patterns in crisis responses for youth one year before and after Harvey's landfall. A quasi-experimental difference-in-differences analysis compared changes in texts for stress/anxiety, depression, thoughts of suicide, and self-harm following Harvey between exposed and unexposed youth in Texas., Results: CTL users with Texas-based area codes (N = 23,016) were compriesd largely of youth who self-identified as female (78.1 %), 14-17 year old (50.4 %), white (38.9 %), and LGBTQ+ (51.2 %). We observed parallel increases in crisis texts for depression and thoughts of suicide in most months following Harvey among exposed and unexposed youth. However, non-impacted youth had significantly larger increases in texts for depression up to three months post-Harvey and thoughts of suicide one year after Harvey compared to directly impacted communities., Limitations: Sample size was restricted to texters who completed the post-conversation demographics survey, who may fundamentally differ from those who declined to respond. Harvey exposure was determined using texter area code and county-level disaster declarations, limiting our ability to guarantee individual-level exposure., Conclusions: Texas youth traditionally considered unexposed experienced nearly identical increases in concerns of depression and thoughts of suicide to those directly exposed. Findings suggest spillover effects (e.g., economic concerns, media exposure) may contribute to statewide impacts on youth mental health after natural disasters., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

In late summer and autumn, the passage of intense tropical cyclones can profoundly perturb oceanic and coastal ecosystems. Direct negative effects on individuals and marine communities can be dramatic, especially in the coastal zone, 1 , However, cyclone impacts on open ocean marine life remain poorly understood. Here, we investigate their effects on the foraging movements of a wide-ranging higher predator, the Desertas petrel (Pterodroma deserta), in the mid-latitude North Atlantic during hurricane season. Contrary to previously studied pelagic seabirds in tropical and mid-latitude regions, 2 , 3 , 4 but cyclones can also enhance pelagic primary and secondary production. 5 , 6 , 7 , 8 , 9 However, cyclone impacts on open ocean marine life remain poorly understood. Here, we investigate their effects on the foraging movements of a wide-ranging higher predator, the Desertas petrel (Pterodroma deserta), in the mid-latitude North Atlantic during hurricane season. Contrary to previously studied pelagic seabirds in tropical and mid-latitude regions, 10 , 11 Desertas petrels did not avoid cyclones by altering course, nor did they seek calmer conditions within the cyclone eye. Approximately one-third of petrels tracked from their breeding colony interacted with approaching cyclones. Upon encountering strong winds, the birds reduced ground speed, likely by spending less time in flight. A quarter of birds followed cyclone wakes for days and over thousands of kilometers, a behavior documented here for the first time. Within these wakes, tailwind support was higher than along alternative routes. Furthermore, at the mesoscale (hours-weeks and hundreds of kilometers), sea surface temperature dropped and surface chlorophyll sharply increased, suggesting direct effects on ocean stratification, primary production, and therefore presumably prey abundance and accessibility for surface-feeding petrels. We therefore hypothesize that cyclone wakes provide both predictably favorable wind conditions and foraging opportunities. As such, cyclones may have positive net effects on the demography of many mid-latitude pelagic seabirds and, likely, other marine top-predators., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Mangrove canopy height (MCH) has been described as a leading characteristic of mangrove forests, protecting coastal economic interests from hurricanes. Meanwhile, winter temperature has been considered the main factor controlling the MCH along subtropical coastlines. However, the MCH in Cedar Key, Florida (∼12 m), is significantly higher than in Port Fourchon, Louisiana (∼2.5 m), even though these two subtropical locations have similar winter temperatures. Port Fourchon has been more frequently impacted by hurricanes than Cedar Key, suggesting that hurricanes may have limited the MCH in Port Fourchon rather than simply winter temperatures. This hypothesis was evaluated using novel high-resolution remote sensing techniques that tracked the MCH changes between 2002 and 2023. Results indicate that hurricanes were the limiting factor keeping the mean MCH at Port Fourchon to <1 m (2002-2013), as the absence of hurricane impacts between 2013 and 2018 allowed the mean MCH to increase by 60 cm despite the winter freezes in Jan/2014 and Jan/2018. Hurricanes Zeta (2020) and Ida (2021) caused a decrease in the mean MCH by 20 cm, breaking branches, defoliating the canopy, and toppling trees. The mean MCH (∼1.6 m) attained before Zeta and Ida has not yet been recovered as of August 2023 (∼1.4 m), suggesting a longer-lasting impact (>4 years) of hurricanes on mangroves than winter freezes (<1 year). The high frequency of hurricanes affecting mangroves at Port Fourchon has acted as a periodic "pruning," particularly of the tallest Avicennia trees, inhibiting their natural growth rates even during quiet periods following hurricane events (e.g., 12 cm/yr, 2013-2018). By contrast, the absence of hurricanes in Cedar Key (2000-2020) has allowed the MCH to reach 12 m (44-50 cm/yr), implying that, besides the winter temperature, the frequency and intensity of hurricanes are important factors limiting the MCH on their latitudinal range limits in the Gulf of Mexico., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Published by Elsevier B.V.)

Each year, an average of 45 tropical cyclones affect coastal areas and potentially impact forests. The proportion of the most intense cyclones has increased over the past four decades and is predicted to continue to do so. Yet, it remains uncertain how topographical exposure and tree characteristics can mediate the damage caused by increasing wind speed. Here, we compiled empirical data on the damage caused by 11 cyclones occurring over the past 40 years, from 74 forest plots representing tropical regions worldwide, encompassing field data for 22,176 trees and 815 species. We reconstructed the wind structure of those tropical cyclones to estimate the maximum sustained wind speed (MSW) and wind direction at the studied plots. Then, we used a causal inference framework combined with Bayesian generalised linear mixed models to understand and quantify the causal effects of MSW, topographical exposure to wind (EXP), tree size (DBH) and species wood density (ρ) on the proportion of damaged trees at the community level, and on the probability of snapping or uprooting at the tree level. The probability of snapping or uprooting at the tree level and, hence, the proportion of damaged trees at the community level, increased with increasing MSW, and with increasing EXP accentuating the damaging effects of cyclones, in particular at higher wind speeds. Higher ρ decreased the probability of snapping and to a lesser extent of uprooting. Larger trees tended to have lower probabilities of snapping but increased probabilities of uprooting. Importantly, the effect of ρ decreasing the probabilities of snapping was more marked for smaller than larger trees and was further accentuated at higher MSW. Our work emphasises how local topography, tree size and species wood density together mediate cyclone damage to tropical forests, facilitating better predictions of the impacts of such disturbances in an increasingly windier world., (© 2024 The Authors. Global Change Biology published by John Wiley & Sons Ltd.)

Many trees exhibit masting - where reproduction is temporally variable and synchronous over large areas. Several dominant masting species occur in tropical cyclone (TC)-prone regions, but it is unknown whether TCs correlate with mast seeding. We analyzed long-term data (1958-2022) to test the hypothesis that TCs influence cone production in longleaf pine (Pinus palustris). We integrate field observations, weather data, satellite imagery, and hurricane models to test whether TCs influence cone production via: increased precipitation; canopy density reduction; and/or mechanical stress from wind. Cone production was 31% higher 1 yr after hurricanes and 71% higher after 2 yr, before returning to baseline levels. Cyclone-associated precipitation was correlated with increased cone production in wet years and cone production increased after low-intensity winds (≤ 25 m s -1 ) but not with high-intensity winds (> 25 m s -1 ). Tropical cyclones may stimulate cone production via precipitation addition, but high-intensity winds may offset any gains. Our study is the first to support the direct influence of TCs on reproduction, suggesting a previously unknown environmental correlate of masting, which may occur in hurricane-prone forests world-wide., (© 2023 The Authors New Phytologist © 2023 New Phytologist Foundation This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.)

Importance: Evidence suggests warming temperatures are associated with the spread of potentially pathogenic Vibrio spp. and the emergence of human disease globally. Following Hurricane Ian, the State of Florida reported a sharp increase in the number of reported Vibrio spp. infections and deaths. Hence, monitoring of pathogens, including vibrios, and environmental parameters influencing their occurrence is critical to public health. Here, DNA sequencing was used to investigate the genomic diversity of Vibrio parahaemolyticus and Vibrio vulnificus , both potential human pathogens, in Florida coastal waters post Hurricane Ian, in October 2022. Additionally, the microbial community of water samples was profiled to detect the presence of Vibrio spp. and other microorganisms (bacteria, fungi, protists, and viruses) present in the samples. Long-term environmental data analysis showed changes in environmental parameters during and after Ian were optimal for the growth of Vibrio spp. and related pathogens. Collectively, results will be used to develop predictive risk models during climate change., Competing Interests: The authors declare the following potential conflict of interest with respect to the research, authorship, and/or publication of this article: Dr. Nur A. Hasan and Michael Netherland, Jr., were employed by EzBiome Inc., Gaithersburg, MD, at the time this work was completed. Specific roles of the authors are articulated in the "author contributions" section. This does not alter our decision to publish or adherences to policies on sharing data and materials. All other co-authors do not have any competing interest.

We highlight critical public healthcare inadequacies for older adult populations resulting in fatalities after Hurricane Ian. We summarize whether a fatality was a result of the storm directly, indirectly, or not at all. Massive destruction from Ian eliminated critical life-sustaining health care for the week following the hurricane. This disproportionately affected the older adult population, with most elder deaths attributed to a lack of some form of health care. To prevent further unnecessary deaths following a disaster event, we recommend that public health policy practitioners, medical practitioners, and state officials consider how to provide managed opt-in emergency care services, mobile elderly care until restoration of power and services, and revisions to community-based critical care provider building codes to include generators and fuel. We offer this viewpoint to generate discussion among public health and emergency planners., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)

Objective: The coronavirus disease 2019 (COVID-19) pandemic as well as other recent natural emergencies have put the spotlight on emergency planning. One important aspect is that natural disasters or emergencies often lead to indirect deaths, and studying the behavior of indirect deaths during emergencies can guide emergency planning. While many studies have suggested many indirect deaths in Puerto Rico due to Hurricane Maria; the specific causes of these deaths have not been carefully studied., Methods: In this study, we use a semiparametric model and mortality data to evaluate cause of death trends. Our model adjusts for cause of death effect potentially varying over time while also inferring on how long excess deaths occurred., Results: From September 2017 to March 2018, after adjusting for intra-annual variability and population displacement, we find evidence of significant excess deaths due to Alzheimer's/Parkinson, heart disease, sepsis, diabetes, renal failure, and pneumonia and influenza., Conclusions: In contrast, for the same time period we find no evidence of significant excess deaths due to cancer, hypertension, respiratory diseases, cerebrovascular disease, suicide, homicide, falling accidents, and traffic accidents.

Objectives: Ideally, mosquito control programs (MCPs) use surveillance to target control measures to potentially dangerous mosquito populations. In North Carolina (NC), where there is limited financial support for mosquito control, communities may suffer from mosquito-related issues post-hurricane due to lack of existing MCPs. Here, study objectives were to (1) investigate the emergency response of a subset of NC counties post-Hurricane Florence and (2) develop guidelines and policy recommendations to assist MCPs in post-hurricane mosquito control response., Methods: A survey was administered to a subset of eastern NC counties (an area previously impacted by hurricanes) with various levels of MCPs (from none to well-developed)., Results: All respondents indicated that having Federal Emergency Management Agency (FEMA) training would be helpful in developing a post-hurricane emergency response plan for mosquito control. There was concern related to a lack of knowledge of emergency control methods (eg, aerial/ground, adulticiding/larviciding) post-hurricane. MCP structure (eg, infrastructure, resources, operational plans/policies) could facilitate response activities and help ensure necessary emergency financial support from agencies such as FEMA., Conclusions: Mosquito control post-hurricane protects public health. Public health and other agencies can be networking resources for MCPs. Policy recommendations include implementation of routine FEMA assistance training workshops to improve an understanding of processes involved in assistance and reimbursement.

Background: Limited research on food systems and food insecurity (FI) following disasters finds contextual differences in post-disaster food systems that shape dimensions of FI. Measurement limitations make it difficult to address FI and develop effective practices for disaster-affected communities., Objective: To develop, validate, and test a Disaster Food Security Framework (DFSF)., Design: Mixed-methods approach was used, including in-depth interviews to understand lived experiences during disasters; expert panel input to validate DFSF designed using responses from in-depth interviews; and quantitative testing of robustness of DFSF using the coronavirus disease 2019 pandemic as a disaster example., Participants and Setting: The in-depth interviews included participants from Vermont (n = 5), North Carolina (n = 3), and Oklahoma (n = 2) who had been living in those states during Hurricane Irene (2011), Hurricane Florence (2018), the Moore tornadoes (2013), and coronavirus disease 2019 pandemic (2020). The expert panel consisted of researchers and practitioners from different US geographical regions and food-related disciplines (n = 18). For the quantitative testing survey, data from 4 US states (New York, New Mexico, Vermont, and Maryland; n = 3,228) from the National Food Access and COVID Research Team was used., Main Outcome Measures: The outcomes from the in-depth interviews were dimensions of disaster FI, those from the expert panel was a content validity ratio, and those from the quantitative testing was the number of items and components to be included., Analyses Performed: Inductive and deductive reasoning were using when reporting on the in-depth interviews and expert panel results, including frequencies. The quantitative testing was conducted using multiple correspondence analysis., Results: The in-depth interviews revealed four dimensions of FI: availability (supply and donation), accessibility (economic, physical, and social), acceptability (preference and health), and agency (infrastructure and self-efficacy). The panel of experts reported high content validity for the DFSF and its dimensions (content validity ratio >0.42), thus giving higher credibility to the DFSF. Multiple correspondence analysis performed on 25 food-related variables identified one component with 13 indicators representing three of the four dimensions: availability, acceptability, and accessibility, but not agency., (Copyright © 2023 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of this study was to look at a cohort of adolescents who were already enrolled in a randomized controlled trial to see (1) how demographics were associated with hurricane impact, and (2) how hurricane impact was associated with reported asthma quality of life., Methods: One hundred fifty-one adolescents ages 11-17 and their parents enrolled in a randomized controlled trial at 2 sites in southeastern North Carolina completed questions about asthma quality of life, demographics, and the impact of Hurricane Matthew., Results: The most common effects of Hurricane Matthew were that the family's home was damaged or flooded (32.5%), the school was damaged or flooded (31.8%), and the home had mold or mildew as a result of flooding or damage (25.8%). Problems with access to care were more common for families whose adolescent was non-White ( P = 0.04), on Medicaid ( P = 0.05), or if the family spoke Spanish at home ( P < 0.001). Being affected by the hurricane was negatively associated with asthma quality of life., Conclusions: Hurricane Matthew had significant impact on the health of adolescents with asthma in the affected region, especially in the most vulnerable populations. Providers should ensure that families of adolescents with asthma have a hurricane plan to mitigate impact on their children's health.

In September 2017, Hurricane Irma made landfall in South Florida, causing a great deal of damage to mangrove forests along the southwest coast. A combination of hurricane strength winds and high storm surge across the area resulted in canopy defoliation, broken branches, and downed trees. Evaluating changes in mangrove forest structure is significant, as a loss or change in mangrove forest structure can lead to loss in the ecosystems services that they provide. In this study, we used lidar remote sensing technology and field data to assess damage to the South Florida mangrove forests from Hurricane Irma. Lidar data provided an opportunity to investigate changes in mangrove forests using 3D high-resolution data to assess hurricane-induced changes at different tree structure levels. Using lidar data in conjunction with field observations, we were able to model aboveground necromass (AGN; standing dead trees) on a regional scale across the Shark River and Harney River within Everglades National Park. AGN estimates were higher in the mouth and downstream section of Shark River and higher in the downstream section of the Harney River, with higher impact observed in Shark River. Mean AGN estimates were 46 Mg/ha in Shark River and 38 Mg/ha in Harney River and an average loss of 29% in biomass, showing a significant damage when compared to other areas impacted by Hurricane Irma and previous disturbances in our study region.

Background: Mental health disorders have an increased prevalence in communities that experienced devastating natural disasters. Maria, a category 5 hurricane, struck Puerto Rico on September 20, 2017, weakening the island's power grid, destroying buildings and homes, and limiting access to water, food, and health care services. This study characterized sociodemographic and behavioral variables and their association with mental health outcomes in the aftermath of Hurricane Maria., Methods: A sample of 998 Puerto Ricans affected by Hurricane Maria was surveyed between December 2017 and September 2018. Participants completed a 5-tool questionnaire: Post-Hurricane Distress Scale, Kessler K6, Patient Health Questionnaire 9, Generalized Anxiety Disorder (GAD) 7, and Post-Traumatic Stress Disorder checklist for DSM-V. The associations of sociodemographic variables and risk factors with mental health disorder risk outcomes were analyzed using logistic regression analysis., Results: Most respondents reported experiencing hurricane-related stressors. Urban respondents reported a higher incidence of exposure to stressors when compared to rural respondents. Low income (OR = 3.66; 95% CI = 1.34-11.400; p < 0.05) and level of education (OR = 4.38; 95% CI = 1.20-15.800; p < 0.05) were associated with increased risk for severe mental illness (SMI), while being employed was correlated with lower risk for GAD (OR = 0.48; 95% CI = 0.275-0.811; p < 0.01) and lower risk for SIM (OR = 0.68; 95% CI = 0.483-0.952; p < 0.05). Abuse of prescribed narcotics was associated with an increased risk for depression (OR = 2.94; 95% CI = 1.101-7.721; p < 0.05), while illicit drug use was associated with increased risk for GAD (OR = 6.56; 95% CI = 1.414-39.54; p < 0.05)., Conclusion: Findings underline the necessity for implementing a post-natural disaster response plan to address mental health with community-based social interventions., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Trends in 2-1-1 calls reflect evolving community needs during public health emergencies (PHEs). The study examined how changes in 2-1-1 call volume after 2 PHEs (Hurricane Irma and the coronavirus disease 2019 [COVID-19] pandemic declaration) in Broward County, Florida, varied by PHE type and whether variations differed by gender and over time. Examining 2-1-1 calls during June to December 2016, June to December 2017, and March 2019 to April 2021, this study measured changes in call volume post-PHEs using interrupted time series analysis. Hurricane Irma and the COVID-19 pandemic were associated with increases in call volume (+81 calls/d and +84 calls/d, respectively). Stratified by gender, these PHEs were associated with larger absolute increases for women (+66 and +57 calls/d vs +15 and +27 calls/d for men) but larger percent increases above their baseline for men (+143% and +174% vs +119% and +138% for women). Calls by women remained elevated longer after Hurricane Irma (5 wk vs 1 wk), but the opposite pattern was observed after the pandemic declaration (8 vs 21 wk). PHEs reduce gender differences in help-seeking around health-related social needs. Findings demonstrate the utility of 2-1-1 call data for monitoring and responding to evolving community needs in the PHE context.

Objective: To evaluate the impact of Hurricanes Irma/Maria on diabetes incidence in Puerto Rico. Mortality increased substantially after the hurricanes, but morbidity was not assessed., Methods: We recruited 364 participants from the San Juan Overweight Adults Longitudinal Study (SOALS) aged 40-65 years who completed a three-year follow-up and were free of diabetes. We conducted additional questionnaires 1.7-2.5 years after hurricanes. Glycosylated hemoglobin (HbA1c), fasting glucose and insulin were assessed at all three visits. We compared diabetes incidence between pre-hurricane visits and between visits spanning the hurricanes using Generalized Estimating Equation (GEE) adjusting for within person repeated measures, age, and body mass index (BMI)., Results: Diabetes incidence was significantly higher spanning the hurricanes than pre-hurricane (multivariate GEE model: IRR = 2.1; 95% CI: 1.4-3.1). There was a significantly higher increase spanning the hurricanes compared to pre-hurricanes for Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) (median: 0.3 uIU/mL vs. 0.2 uIU/mL). HbA1c levels increased by 0.4% spanning the hurricanes., Conclusion: Increases in diabetes incidence, HOMA-IR and HbA1c were higher spanning the hurricanes compared to the pre-hurricanes period. The increase in diabetes incidence remains significant after adjusting for age and BMI., (© 2023. The Author(s).)

Hurricane Harvey caused unprecedented floods across large regions of Southeast Texas resulting in several infrastructural issues. One of the notable failures was of a drinking water source pump in Beaumont, Texas, that necessitated the emergency use of a temporary pump intake station in the Neches River system. This study examines the environmental consequences of Harvey-induced flooding in the Neches River system by focusing on sensitive locations, including a Superfund site (International Creosoting, IC) and adjacent to the temporary pump intake. Post-Harvey water samples showed greater than two orders of magnitude increase in polycyclic aromatic hydrocarbons (PAH) about 3 weeks after Harvey (350-420 µg L -1 on September 22) at locations adjacent to IC and the temporary water pump intake, which by that time was no longer in use. The organic carbon normalized PAH measurements in the heavily contaminated water samples from both locations (~3% w/w) agreed well with surficial soil/sediment samples collected at the east bank adjacent to the IC site (0.7-5.2% w/w). Furthermore, molecular diagnostic ratios of select PAHs supported the contribution of PAHs from the IC site into the surface waters. PAH measurements were consistent with sediment resuspension by floodwaters that were initially diluted by large flows but became more significant as the flood subsided. Overall, our data showed that flooding can cause high levels of contamination weeks after the initial flooding event, with potential for cascading risks through mobilization of pollutants from source areas and impacts to critical water infrastructure systems., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objectives: The objective of this study was to assess recovery of Aransas County, Texas households 2 years after Category 4 Hurricane Harvey made landfall., Methods: A 2-stage cluster sampling method used to conduct a Community Assessment for Public Health Emergency Response (CASPER) on May 3 - 4 and May 18 - 19, 2019. A household-based survey was administered through face-to-face interviews, selected through systematic random sampling using weighted analysis of the county population. Field teams collected 175 surveys (83.3% completion rate)., Results: Approximately 57% households experienced repairable damage, 23% had destroyed homes, and 19% had minimal damage. 38% stated having 'no need,' 18% needed financial assistance, 16% needed household repairs, and over 8% had behavioral health needs. 17% experiencing a behavioral health concern were seeking services. Of the 35% of households who did not seek services, 14% felt there was no need, and 4% were not aware of the resources available., Conclusions: Households reported high levels of preparedness, but gaps remain in evacuation intention and behavioral health care access. CASPERs are effective in assessing long-term recovery of communities impacted by major disasters.

The impact of hurricane-related flooding on infectious diseases in the US is not well understood. Using geocoded electronic health records for 62,762 veterans living in North Carolina counties impacted by Hurricane Matthew coupled with flood maps, we explore the impact of hurricane and flood exposure on infectious outcomes in outpatient settings and emergency departments as well as antimicrobial prescribing. Declines in outpatient visits and antimicrobial prescribing are observed in weeks 0-2 following the hurricane as compared with the baseline period and the year prior, while increases in antimicrobial prescribing are observed 3+ weeks following the hurricane. Taken together, hurricane and flood exposure appear to have had minor impacts on infectious outcomes in North Carolina veterans, not resulting in large increases in infections or antimicrobial prescribing.

Background: This two-study paper developed a climate change risk perception model that considers the role of posttraumatic growth (i.e., a reappraisal of life priorities and deeper appreciation of life), resource loss, posttraumatic stress, coping, and social support., Method: In Study 1, participants were 332 persons in the Philippines who experienced Super Typhoon Haiyan. In Study 2, participants were 709 persons in Fiji who experienced Cyclone Winston. Climate change can increase the size and destructive potential of cyclones and typhoons as a result of warming ocean temperatures, which provides fuel for these storms. Participants completed measures assessing resource loss, posttraumatic stress, coping, social support, posttraumatic growth, and climate change risk perception., Results: Structural equation modeling was used to develop a climate change risk perception model with data collected in the Philippines and to confirm the model with data collected in Fiji. The model showed that climate change risk perception was influenced by resource loss, posttraumatic stress, coping activation, and posttraumatic growth. The model developed in the Philippines was confirmed with data collected in Fiji., Conclusions: Posttraumatic growth played a central role in climate change risk perception. Public health educational efforts should focus on vividly showing how climate change threatens life priorities and that which gives life meaning and can result in loss, stress, and hardship. Disaster response organizations may also use this approach to promote preparedness for disaster threats.

Background: As the climate continues to warm, hurricanes will continue to increase in both severity and frequency. Hurricane damage is associated with cardiovascular events, but social capital may moderate this relationship. Social capital is a multidimensional concept with a rich theoretical tradition. Simply put, social capital refers to the social relationships and structures that provide individuals with material, financial, and emotional resources throughout their lives. Previous research has found an association between high levels of social capital and lower rates of cardiovascular (CVD) mortality. In post-disaster settings, social capital may protect against CVD mortality by improving access to life-saving resources. We examined the association between county-level hurricane damage and CVD mortality rates after Hurricane Matthew, and the moderating effect of several aspects of social capital and hurricane damage on this relationship. We hypothesized that (1) higher (vs. lower) levels of hurricane damage would be associated with increased CVD mortality rates and (2) in highly damaged counties, higher (vs. lower) levels of social capital would be associated with lower CVD mortality., Methods: Analysis used yearly (2013-2018) county-level sociodemographic and epidemiological data (n = 183). Sociodemographic data were compiled from federal surveys before and after Hurricane Matthew to construct, per prior literature, a social capital index based on four dimensions of social capital (sub-indices): family unity, informal civil society, institutional confidence, and collective efficacy. Epidemiological data comprised monthly CVD mortality rates constructed from monthly county-level CVD death counts from the CDC WONDER database and the US Census population estimates. Changes in CVD mortality based on level of hurricane damage were assessed using regression adjustment. We used cluster robust Poisson population average models to determine the moderating effect of social capital on CVD mortality rates in both high and low-damage counties., Results: We found that mean levels of CVD mortality increased (before and after adjustment for sociodemographic controls) in both low-damage counties (unadjusted. Mean = 2.50, 95% CI [2.41, 2.59], adjusted mean = 2.50, 95% CI [2.40, 2.72]) and high-damage counties (mean = 2.44, CI [2.29, 2.46], adj. Mean = 2.51, 95% CI [2.49, 2.84]). Among the different social capital dimensions, institutional confidence was associated with reduced initial CVD mortality in low-damage counties (unadj. IRR 1.00, 95% CI [0.90, 1.11], adj. IRR 0.91 CI [0.87, 0.94]), but its association with CVD mortality trends was null. The overall effects of social capital and its sub-indices were largely nonsignificant., Conclusion: Hurricane damage is associated with increased CVD mortality for 18 months after Hurricane Matthew. The role of social capital remains unclear. Future research should focus on improving measurement of social capital and quality of hurricane damage and CVD mortality data., (© 2023. The Author(s).)

Background: Studies of effects of hurricanes on perinatal outcomes often rely on approximate measures of exposure. This study aims to use observed damage from aerial imagery to refine residential building damage estimates, evaluate the population changes post landfall, and assess the associations between the extent of residential building damage and adverse perinatal outcomes and access to prenatal care (PNC) services.  METHODS: Vital statistics data from the Florida Department of Health's Office of Vital Statistics were used to align maternal geocoded address data to high-resolution imagery (0.5-foot resolution, true color with red, blue, and green bands) aerial photographs. Machine learning (support vector machines) classified residential roof damage across the study area. Perinatal outcomes were compared with the presence or absence of damage to the mother's home. Log-binomial regression models were used to compare the populations living in and outside of high-risk/damage areas, to assess the population changes after Hurricane Michael, and to estimate the associations between damage after Hurricane Michael and adverse perinatal outcomes/access to PNC services. A semi-parametric linear model was used to model time of first PNC visit and increase in damage., Results: We included 8,965 women in analysis. Women with lower education and/or of Black or other non-White race/ethnicity were more likely to live in areas that would see high damage than other groups. Moreover, there was a greater proportion of births delivered by women living in the high-risk/damage area (> 25% damaged parcels after Michael) in the year before Michael than the year after Michael. Lastly, living in the area with relatively high damage increased the risk of having intermediate or inadequate PNC (adjusted Risk Ratio = 1.21, 95% CI: 1.03, 1.43), but not other adverse perinatal outcomes., Conclusions: Aerially observed damage data enable us to evaluate the impact of natural disasters on perinatal outcomes and access to PNC services based on residential building damage immediately surrounding a household. The association between the extent of damage and adverse perinatal outcomes should be further investigated in future studies., (© 2022. The Author(s).)

Background: Coinciding with the rising non-communicable disease (NCD) prevalence worldwide is the increasing frequency and severity of natural hazards. Protecting populations with NCDs against natural hazards is ever more pressing given their increased risk of morbidity and mortality in disaster contexts. This investigation examined Hurricane Maria's impacts across ten lower SES municipalities in Puerto Rico with varying community characteristics and hurricane impacts to understand experiences of supporting individuals with NCD management in the six-month period following the hurricane., Methods: We conducted 40 qualitative interviews with mayors, first responders, faith leaders, community leaders, and municipal employees from 10 municipalities in Puerto Rico. Using QSR NVivo software, we deductively and inductively coded interview transcripts and undertook thematic analysis to characterize community-level hurricane impact and consequences for NCD management, and to identify convergent and divergent themes., Results: Damages to infrastructure, including healthcare facilities and roadways, complicated the provision of timely health care for NCDs, patient transport, and pharmaceutical/medical supply chain continuity. Lengthy power outages at both healthcare facilities and private residences were barriers to healthcare service delivery, use of medical equipment, and storage of prescription medications with refrigeration, and led to a widespread mental health crisis. Cascading failures such as fuel shortages further compounded these challenges. The consequences of these impacts included the reported exacerbation of health conditions and loss of life among NCD patients., Conclusions: Study findings identify contributors to morbidity and mortality among individuals with NCDs following Hurricane Maria. With the growing frequency of catastrophic disasters from natural hazards, the experiences of communities that endured these impacts offer important lessons regarding policies and practices to better support community disaster resilience and address the evolving preparedness needs of NCD patients., (© 2022. The Author(s).)

Cyclones can cause mass mortality of seabirds, sometimes wrecking thousands of individuals. The few studies to track pelagic seabirds during cyclones show they tend to circumnavigate the strongest winds. We tracked adult shearwaters in the Sea of Japan over 11 y and found that the response to cyclones varied according to the wind speed and direction. In strong winds, birds that were sandwiched between the storm and mainland Japan flew away from land and toward the eye of the storm, flying within ≤30 km of the eye and tracking it for up to 8 h. This exposed shearwaters to some of the highest wind speeds near the eye wall (≤21 m s -1 ) but enabled them to avoid strong onshore winds in the storm's wake. Extreme winds may therefore become a threat when an inability to compensate for drift could lead to forced landings and collisions. Birds may need to know where land is in order to avoid it. This provides additional selective pressure for a map sense and could explain why juvenile shearwaters, which lack a map sense, instead navigating using a compass heading, are susceptible to being wrecked. We suggest that the ability to respond to storms is influenced by both flight and navigational capacities. This may become increasingly pertinent due to changes in extreme weather patterns.

Background: The provision of food aid after a natural disaster is necessary to prevent hunger, particularly in low-resourced and low-income communities. Little is known about the operational challenges associated with ensuring equitable distribution of emergency food resources to communities in need following a disaster. To address this gap, this study assessed emergency food distribution efforts in New Orleans, LA during the 2 weeks following Hurricane Ida's landfall on August 29, 2021., Methods: Information on free food distribution events was gathered from online sources. A list of distribution sites was generated that included data on operational logistics (e.g., address, days of operation, hours of operation, etc.), food offerings (e.g., prepared meals, groceries, etc.), and socio-demographic characteristics of the surrounding community. Geospatial mapping and bivariate analyses were used to analyze the site data., Results: Seventy-four distribution sites operated in the 2 weeks after Hurricane Ida. Approximately 47.3% were located in census tracts with >80% Black residents, and 39.2% were in tracts with >30% poverty. A large proportion of sites offered prepared meals (86.2%) and only operated 1 day (36.5%). Tracts with >80% Black residents had more sites that operated only 1 day ( p = 0.04). Tracts with >30% poverty had more sites that started distributing food resources 7-15 days after the hurricane ( p = 0.02)., Conclusions: Most low-income and low-resourced communities in New Orleans had access to emergency food resources; however, several limitations in operations were identified that may have influenced access. Future initiatives to prevent hunger after a natural disaster in New Orleans, and elsewhere, should improve operational logistics for food aid., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Singleton, Chaparro, O'Malley, Fuster and Rose.)

Background: Nursing home (NH) residents are vulnerable to increased mortality after a natural disaster such as hurricanes but the specific vulnerability of NH residents on hospice and the impact on admission to hospice are unknown. Objectives: Exposure to Hurricane Irma (2017) was used to evaluate increased mortality among Florida NH residents by hospice status compared with the same time period in a nonhurricane year. Difference in hospice utilization rates poststorm for short- and long-stay NH residents was also examined. Setting/Subjects: Subject were all Florida NH residents of age 65 years and older utilizing fee-for-service Medicare claims data exposed to Hurricane Irma in 2017 compared with a control group of residents residing at the same NHs in 2015. Analysis: Mortality rates were calculated by hospice status, rates of hospice enrollment, and the corresponding odds ratios (ORs). Results: Hurricane exposure was associated with an increase in mortality 30 days poststorm (OR = 1.12, 95% confidence interval [CI]: 1.00-1.26) but not 90 days poststorm (OR = 1.02, 95% CI: 0.95-1.10) for residents on hospice. For the rate of hospice enrollment poststorm among residents previously not on hospice, there was an increase in odds of enrollment among long-stay residents in 30 days (OR = 1.15, 95% CI: 1.02-1.23) and 90 days (OR = 1.12, 95% CI: 1.05-1.20) but not short-stay residents within 30 (OR = 1.02, 95% CI: 0.91-1.15) and 90 days (OR = 1.07, 95% CI: 0.99-1.15). Conclusion: Mortality in NH residents on hospice care increased in the aftermath of Hurricane Irma. In addition, NH residents not on hospice were more likely to be referred to hospice in the 30 days after the storm.

While tropical cyclone regimes are shifting with climate change, the mechanisms underpinning the resistance (ability to withstand disturbance-induced change) and resilience (capacity to return to pre-disturbance reference) of tropical forest litterfall to cyclones remain largely unexplored pantropically. Single-site studies in Australia and Hawaii suggest that litterfall on low-phosphorus (P) soils is more resistant and less resilient to cyclones. We conducted a meta-analysis to investigate the pantropical importance of total soil P in mediating forest litterfall resistance and resilience to 22 tropical cyclones. We evaluated cyclone-induced and post-cyclone litterfall mass (g/m 2 /day), and P and nitrogen (N) fluxes (mg/m 2 /day) and concentrations (mg/g), all indicators of ecosystem function and essential for nutrient cycling. Across 73 case studies in Australia, Guadeloupe, Hawaii, Mexico, Puerto Rico, and Taiwan, total litterfall mass flux increased from ~2.5 ± 0.3 to 22.5 ± 3 g/m 2 /day due to cyclones, with large variation among studies. Litterfall P and N fluxes post-cyclone represented ~5% and 10% of the average annual fluxes, respectively. Post-cyclone leaf litterfall N and P concentrations were 21.6 ± 1.2% and 58.6 ± 2.3% higher than pre-cyclone means. Mixed-effects models determined that soil P negatively moderated the pantropical litterfall resistance to cyclones, with a 100 mg P/kg increase in soil P corresponding to a 32% to 38% decrease in resistance. Based on 33% of the resistance case studies, total litterfall mass flux reached pre-disturbance levels within one-year post-disturbance. A GAMM indicated that soil P, gale wind duration and time post-cyclone jointly moderate the short-term resilience of total litterfall, with the nature of the relationship between resilience and soil P contingent on time and wind duration. Across pantropical forests observed to date, our results indicate that litterfall resistance and resilience in the face of intensifying cyclones will be partially determined by total soil P., (© 2022 John Wiley & Sons Ltd.)

Objectives: Hurricane Sandy made landfall across New York City (NYC) in October 2012, but the long-term consequences of the storm are still not fully understood. We analyzed NYC data to quantify the extent of Hurricane Sandy-related concerns over time., Methods: Data on NYC 311 Call Center inquiries were downloaded from the NYC Open Data website (October 29, 2012 to May 26, 2020) to provide information about Sandy-related calls using the keywords "Hurricane" and "Sandy"., Results: In the first 2 wk after Hurricane Sandy, 15.6% of 311 calls were related to the storm. From 2012 to 2020, the volume of inquiries decreased from 87,209 to 25. The majority of calls in 2012 (49,181; 56%) was requesting general Hurricane Sandy information, and in 2020 assistance with property restoration (20; 79%)., Conclusions: The long-term consequences of Hurricane Sandy in NYC persist into 2020, almost 8 y after the initial event. The needs of Hurricane Sandy victims have changed over time from requiring general information regarding closures, property destruction and immediate disaster relief to aid with legal, financial, and mental health consequences. Disaster response policy-makers must understand the changing needs of NYC residents to provide resources and prepare for future disasters.

Purpose: Hurricane Maria is the most devastating natural phenomenon in the recent history of Puerto Rico. Due to its destructive path through the island, the Puerto Rico Trauma Center (PRTC) remained the only hospital managing orthopaedic trauma in the immediate post-disaster period. We investigated the impact of this hurricane on the orthopaedic trauma epidemiology in the PRTC., Methods: We evaluated the admissions by the orthopaedic surgery service in terms of demographics, mechanisms of injury, and orthopaedic diagnoses for two months after the impact of Hurricane Maria (HM) on September 20, 2017. We compared our study group with the same two month period for two years prior (2015 and 2016) and after (2018 and 2019) as control periods. A p value of < 0.05 was considered statistically significant., Results: We included 384 admissions from September 20 to November 20, 2017. The majority were males (63%) and had an average age of 54 years. The most-reported mechanism of injury was fall from standing height (FFSH), showing a significant increment compared with the control periods. Contrarily, motor vehicle accidents (MVA) showed a significant reduction. Among the orthopaedic diagnoses, the hip + pelvis category showed a significant decline within the study group., Conclusions: This study highlighted the impact of HM on the orthopaedic trauma epidemiology at the PRTC. Our findings provide valuable evidence to healthcare institutions to better prepare to manage the potential changes in the orthopaedic trauma epidemiology after a major atmospheric event., (© 2022. The Author(s) under exclusive licence to SICOT aisbl.)

Objective: In times of repeated disaster events, including natural disasters and pandemics, public health workers must recover rapidly to respond to subsequent events. Understanding predictors of time to recovery and developing predictive models of time to recovery can aid planning and management., Methods: We examined 681 public health workers (21-72 y, M(standard deviation [SD]) = 48.25(10.15); 79% female) 1 mo before (T1) and 9 mo after (T2) the 2005 hurricane season. Demographics, trauma history, social support, time to recover from previous hurricane season, and predisaster work productivity were assessed at T1. T2 assessed previous disaster work, initial emotional response, and personal hurricane injury/damage. The primary outcome was time to recover from the most recent hurricane event., Results: Multivariate analyses found that less support (T1; odds ratio [OR] = .74[95% confidence interval [CI] = .60-.92]), longer previous recovery time (T1; OR = 5.22[95%CI = 3.01-9.08]), lower predisaster work productivity (T1; OR = 1.98[95%CI = 1.08-3.61]), disaster-related personal injury/damage (T2; OR = 3.08[95%CI = 1.70-5.58]), and initial emotional response (T2; OR = 1.71[95%CI = 1.34-2.19]) were associated with longer recovery time (T2)., Conclusions: Recovery time was adversely affected in disaster responders with a history of longer recovery time, personal injury/damage, lower work productivity following prior hurricanes, and initial emotional response, whereas responders with social support had shorter recovery time. Predictors of recovery time should be a focus for disaster preparedness planners.

Objective: Hurricane evacuation is one of the strategies employed by emergency management and other agencies to reduce morbidity and mortality associated with hurricanes. However, factors associated with residents' evacuation decision-making have been inconsistent. In this study, we conducted a statistical meta-analysis to identify factors associated with hurricane evacuation as well as moderators of the evacuation decision., Methods: A systematic literature search identified 36 studies published between 1999 and 2018. Pooled estimates were calculated using random-effects models, and heterogeneity across studies was checked using both Q and I 2 statistics. Meta-regression methods were used to identify moderators. Publication bias was assessed using both visual (funnel plots) and statistical methods., Results: Mobile home residence, perception of risk, female sex, and Hispanic ethnicity were statistically associated with hurricane evacuation, while geographic region modified the relationship between Hispanic race and evacuation., Conclusions: Agencies responsible for preparedness may utilize these findings to identify specific population sub-groups for hurricane evacuation communication and other interventions. Future studies should consider statistical interactions and explore opportunities for research translation to emergency officials.

Objective: To examine the levels of burnout and self-perceived stress in workers at the Puerto Rico Electric Power Authority, who experienced major disasters: Hurricanes Irma and Maria., Methods: A quantitative descriptive cross-sectional study with a non-probabilistic convenience sample was conducted in workers at the Puerto Rico Electric Power Authority. A structured questionnaire was administered to a sample of 163 eligible participants, aged 21 years and older, who participated voluntarily. Using employees of the electric company, the study examined the relationships between burnout and several characteristics (years of employment, existing health conditions, and coping strategies) both before and after Hurricanes Irma and Maria. Burnout was assessed with Gil-Monte's Spanish Burnout Inventory, and self-perceived stress was assessed with the 14-item Perceived Stress Scale., Results: Before the hurricanes, 16.6% of the workers reported high levels of burnout syndrome, while, after the hurricanes, the proportion increased to one-fifth (20.9%). Prior to the 2 hurricanes, more than one-fourth (23.4%) of the sample reported being extremely stressed; after the hurricanes, that proportion increased to 55%. Factors such as years of employment, counseling, and self-perceived stress showed significant statistical associations (P < .05) with burnout., Conclusion: From a public health standpoint, priority should be given to this population, thereby preventing burnout and any other negative effects of the aftermath (i.e., the lengthy response, recovery, and reconstruction) of these kinds of major disaster.

Objective: Community characteristics, such as collective efficacy, a measure of community strength, can affect behavioral responses following disasters. We measured collective efficacy 1 month before multiple hurricanes in 2005, and assessed its association to preparedness 9 months following the hurricane season., Methods: Participants were 631 Florida Department of Health workers who responded to multiple hurricanes in 2004 and 2005. They completed questionnaires that were distributed electronically approximately 1 month before (6.2005-T1) and 9 months after (6.2006-T2) several storms over the 2005 hurricane season. Collective efficacy, preparedness behaviors, and socio-demographics were assessed at T1, and preparedness behaviors and hurricane-related characteristics (injury, community-related damage) were assessed at T2. Participant ages ranged from 21-72 ( M ( SD ) = 48.50 (10.15)), and the majority were female (78%)., Results: In linear regression models, univariate analyses indicated that being older ( B = 0.01, SE = 0.003, P < 0.001), White ( B = 0.22, SE = 0.08, P < 0.01), and married ( B = 0.05, SE = 0.02, p < 0.001) was associated with preparedness following the 2005 hurricanes. Multivariate analyses, adjusting for socio-demographics, preparedness (T1), and hurricane-related characteristics (T2), found that higher collective efficacy (T1) was associated with preparedness after the hurricanes ( B = 0.10, SE = 0.03, P < 0.01; and B = 0.47, SE = 0.04, P < 0.001 respectively)., Conclusion: Programs enhancing collective efficacy may be a significant part of prevention practices and promote preparedness efforts before disasters.

The Post-Hurricane Distress Scale (PHDS) was developed to assess mental health risk in the aftermath of hurricanes. We derive both disorder-specific cutoff values and a single nonspecific cutoff for the PHDS for field use by disaster relief and mental health workers. Data from 672 adult residents of Puerto Rico, sampled 3 to 12 months after Hurricane Maria, were collected. Participants completed a five-tool questionnaire packet: PHDS, Kessler K6, Patient Health Questionnaire 9, Generalized Anxiety Disorder 7, and Post-Traumatic Stress Disorder Checklist for DSM V (PCL-5). ROC curves, AUC values, sensitivities, specificities, Youden's index, and LR+ ratios are reported. The recommended single cutoff value for the PHDS is 41, whereby a respondent with a PHDS score of 41 or above is deemed high-risk for a mental health disorder. The single field use PHDS cutoff demonstrated high specificity (0.80), an LR + ratio (2.84), and a sensitivity of 0.56. The mean ROC values of PHDS for Kessler K6, Patient Health Questionnaire 9, Generalized Anxiety Disorder 7, and PCL-5 were all above 0.74. The derived cutoff for the PHDS allows efficient assessment of respondents' and/or a community's risk status for mental health disorders in the aftermath of hurricanes and natural disasters.

Hurricanes can have a significant impact on the functioning and capacity of healthcare systems. However, little work has been done to understand the extent to which hurricanes influence local residents' spatial access to healthcare. Our study evaluates the change in spatial access to primary care physicians (PCPs) between 2016 and 2018 (i.e., before and after Hurricane Harvey) in Harris County, Texas. We used an enhanced 2-step floating catchment area (E2SFCA) method to measure spatial access to PCPs at the census tract level. The results show that, despite an increased supply of PCPs across the county, most census tracts, especially those in the northern and eastern fringe areas, experienced decreased access during this period as measured by the spatial access ratio (SPAR). We explain this decline in SPAR by the shift in the spatial distribution of PCPs to the central areas of Harris County from the fringe areas after Harvey. We also examined the socio-demographic impact in the SPAR change and found little variation in change among different socio-demographic groups. Therefore, public health professionals and disaster managers may use our spatial access measure to highlight the geographic disparities in healthcare systems. In addition, we recommend considering other social and institutional dimensions of access, such as users' needs, preferences, resource capacity, mobility options, and quality of healthcare services, in building a resilient and inclusive post-hurricane healthcare system., (© 2021 Society for Risk Analysis.)

Objective: With the advancement of technology, disaster preparedness related to hurricane hazards can be taught through an app. This study aimed to examine the effect of using an android-based disaster preparedness app on community knowledge and intentional behavior in hurricane risk areas., Methods: A quasi-experimental study was conducted from October to November, 2020 and a total of 80 respondents were recruited using cluster sampling. The treatment group was given the intervention in the form of the disaster preparedness app for 2 weeks. Meanwhile, the control group received home visits and conventional education about hurricane disasters twice throughout the same period. We then used a Wilcoxon Signed Rank test to analyze the pre-test and post-test and a Mann-Whitney U test to compare between treatment and control groups., Results: After the implementation of the SiBen app, we found a statistically significant difference in knowledge between treatment and control groups ( P < 0.003) and intentional behavior between treatment and control groups ( P < 0.001)., Conclusion: The findings indicate that the disaster preparedness app was an effective educational program able to improve the knowledge and intentional behavior among community members in a hurricane risk area.

In August 2017, after Hurricane Harvey made landfall, almost 52 inches of rain fell during a three-day period along the Gulf Coast Region of Texas, including Harris County, where Houston is located. Harris County was heavily impacted with over 177,000 homes and buildings (approximately 12 percent of all buildings in the county) experiencing flooding. The objective of this study was to measure 13 heavy metals in soil in residential areas and to assess cancer and non-cancer risk for children and adults after floodwaters receded. Between September and November 2017, we collected 174 surface soil samples in 10 communities, which were classified as "High Environmental Impact" or "Low Environmental Impact" communities, based on a composite metric of six environmental parameters. A second campaign was conducted between May 2019 and July 2019 when additional 204 soil samples were collected. Concentrations of metals at both sampling campaigns were higher in High Environmental Impact communities than in Low Environmental Impact communities and there was little change in metal levels between the two sampling periods. The Pollution Indices of lead (Pb), zinc, copper, nickel, and manganese in High Environmental Impact communities were significantly higher than those in Low Environmental Impact communities. Further, cancer risk estimates in three communities for arsenic through soil ingestion were greater than 1 in 1,000,000. Although average soil Pb was lower than the benchmark of the United States Environmental Protection Agency, the hazard indices for non-cancer outcomes in three communities, mostly attributed to Pb, were greater than 1. Health risk estimates for children living in these communities were greater than those for adults., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The repercussions of climate change threaten the population with an increased prevalence of extreme climate events. We explored the impact of climate change induced sea level rise (SLR) and tropical cyclone (TC) exposure on mental illness symptom prevalence., Methods: Using three datasets, TC exposure scores were calculated for each subject to determine how exposure affects posttraumatic stress disorder (PTSD), anxiety, and major depressive disorder (MDD) symptom prevalence. Inundation mapping of various SLR and storm surge (SS) scenarios were performed for the susceptible region of Miami-Dade and Broward counties to determine the population impact of flooding., Results: We found an elevated risk of mental illness symptoms from exposure to more high- intensity TCs and identified demographic variables that may contribute to this risk. Furthermore, inundation mapping demonstrated severe and widespread impact of SLR and SS on the mental health of communities., Limitations: This study did not include data directly measuring comorbidity, resilience, preparedness, or ability to adapt to climate change. Also, multiple imputation using chained equations may have been imperfect. Furthermore, there is uncertainty in predicting and mapping SLR and TC intensity, which limits complete confidence in our SS predictions., Conclusion: The impacts of climate change have been frequently studied in terms of physical health, natural disaster prevalence, and economic impacts, but rarely on mental health burden. However, it is vital that national, state, and local governments develop and deploy plans to address mental health needs along with expenditures for protecting infrastructure, the economy, and physical health from the combined effects of SLR and climate change-induced natural disasters., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Objective: Hurricane Sandy made landfall in New Jersey on October 29, 2012, resulting in widespread power outages and gasoline shortages. These events led to potentially toxic exposures and the need for information related to poisons/toxins in the environment. This report characterizes the New Jersey Poison Information and Education System (NJPIES) call patterns in the days immediately preceding, during, and after Hurricane Sandy to identify areas in need of public health education and prevention., Methods: We examined NJPIES case data from October through December 2012. Most Sandy-related calls had been coded as such by NJPIES staff. Additional Sandy-related cases were identified by performing a case narrative review. Descriptive analyses were performed for timing, case frequencies, exposure substances, gender, caller site, type of information requests, and other data., Results: The most frequent Sandy-related exposures were gasoline and carbon monoxide (CO). Gasoline exposure cases were predominantly males and CO exposure cases, females (P < 0.0001). Other leading reasons for Sandy-related calls were poison information, food poisoning/spoilage information, and water contamination., Conclusions: This analysis identified the need for enhanced public health education and intervention to improve the handling of gasoline and encourage the proper use of gasoline-powered generators and cleaning and cooking equipment, thus reducing toxic exposures.

Background: In March 2020, the Louisiana Department of Health activated the Medical Monitoring Station (MMS) in downtown New Orleans. This alternative care site is designed to decompress hospitals and nursing homes overwhelmed by the coronavirus disease 2019 (COVID-19) pandemic. Given the city's historic vulnerability to hurricanes, planning for possible tropical weather events has been a priority for MMS leadership., Methods: The planning process incorporated input from all sectors/agencies working at the facility, to ensure consistency and cohesion. The MMS Shelter-in-Place Plan (MSIPP) was created, and a comprehensive tabletop exercise was conducted., Results: Six planning topics emerged as a result of the planning process and were used to create a comprehensive plan for sheltering-in-place. These topics address hurricane preparedness for patient care, interfacility coordination, wrap-around services, medical logistics, essential staffing, and incident command during a shelter-in-place scenario., Conclusions: The MSIPP created by the MMS helped to maximize patient safety and continuity of operations during a real-world event. Select pieces of the plan were activated to meet the needs and threat level of Tropical Storm Cristobal. This experience reinforced the need for originality, scalability, and flexibility in building emergency operations plans in the midst of an unprecedented pandemic.

Objective: Emergency departments (EDs) are critical sources of care after natural disasters such as hurricanes. Understanding the impact on ED utilization by subpopulation and proximity to the hurricane's path can inform emergency preparedness planning. This study examines changes in ED utilization for residents of 344 counties after the occurrence of 7 US hurricanes between 2005 and 2016., Methods: This retrospective observational study used ED data from the Healthcare Cost and Utilization Project State Inpatient Databases and State Emergency Department Databases. ED utilization rates for weeks during and after hurricanes were compared with pre-hurricane rates, stratified by the proximity of the patient county to the hurricane path, age, and disease category., Results: The overall population rate of weekly ED visits changed little post-hurricane, but rates by disease categories and age demonstrated varying results. Utilization rates for respiratory disorders exhibited the largest post-hurricane increase, particularly 2-3 weeks following the hurricane. The change in population rates by disease categories and age tended to be larger for people residing in counties closer to the hurricane path., Conclusions: Changes in ED utilization following hurricanes depend on disease categories, age, and proximity to the hurricane path. Emergency managers could incorporate these factors into their planning processes.

Rainwater chemistry of extreme rain events is not well characterized. This is despite an increasing trend in intensity and frequency of extreme events and the potential excess loading of elements to ecosystems that can rival annual loading. Thus, an assessment of the loading imposed by hurricane/tropical storm (H/TS) can be valuable for future resiliency strategies. Here the chemical characteristics of H/TS and normal rain (NR) in the US from 2008 to 2019 were determined from available National Atmospheric Deposition Program (NADP) data by correlating NOAA storm tracks with NADP rain collection locations. It found the average pH of H/TS (5.37) was slightly higher (p < 0.05) than that of NR (5.12). On average, H/TS events deposited 14% of rain volume during hurricane season (May to October) at affected collection sites with a maximum contribution reaching 47%. H/TS events contributed a mean of 12% of Ca 2+ , 22% of Mg 2+ , 18% of K + , 25% of Na + , 7% of NH 4 + , 6% of NO 3 - during hurricane season with max loading of 77%, 62%, 94%, 65%, 39%, 34%, 64% and 60%, respectively, which can lead to ecosystems exceeding ion-specific critical loads. Four potential sources (i.e., marine, soil dust, agriculture and industry/fossil fuel) were indicated by PCA. The positive matrix factorization (PMF) suggested Mg - and 11% of SO 4 2- during hurricane season with max loading of 77%, 62%, 94%, 65%, 39%, 34%, 64% and 60%, respectively, which can lead to ecosystems exceeding ion-specific critical loads. Four potential sources (i.e., marine, soil dust, agriculture and industry/fossil fuel) were indicated by PCA. The positive matrix factorization (PMF) suggested Mg 2+ , Na + and Cl - were primarily marine-originated in both event types, while 36% more sea-salt Ca 2+ and 33% more sea-salt SO 4 2- were deposited during H/TS. Agriculture and industry/fossil fuel were the main sources of NH 4 + and NO 3 - , respectively, in both rain event types. However the NH 4 + contribution from industry/fossil fuel increased by 13% during H/TS indicating a potential vehicle source associated with emergency evacuations. This work provides a comprehensive assessment of the rainwater chemistry of H/TS and insight to expected ecosystem loading for future extreme events., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier B.V.)

Anthropogenic tropical deforestation and degradation imminently threaten primates today. Primates living in these disturbed habitats may also be subjected to increasingly severe tropical storms such as cyclones or hurricanes. These disturbances pose an immediate risk to their livelihood and can dramatically alter their habitats, in turn potentially shifting behavioral patterns. We had the unique opportunity to study the effects of seasonality, anthropogenic disturbances, and the immediate effects of a cyclone on the behavior of the critically endangered northern sportive lemur (NSL) in an anthropogenically disturbed forest in Madagascar. Cyclone Enawo made landfall on March 7, 2017 in northeast Madagascar with sustained wind speeds of 230 km/h. We collected behavioral data on nine individual NSLs during both wet and dry seasons, before and after Cyclone Enawo, and in areas of differing human activity, using scan sampling at 5-min intervals. We ran generalized linear mixed models to test the effects of seasonality and disturbances on behavior. We found that NSLs spent more time feeding in dry months compared with wet (Z = -4.21, p < 0.001). More specifically, they spent more time-consuming leaves and vine species in the dry season (Z = -2.26, p = 0.02; Z = -2.3; p = 0.02). We also found that NSLs were observed at lower heights in trees after the cyclone (Z = -2.45; p = 0.016) and spent more time in the interior portions of trees (Z = 3.44; p < 0.001), perhaps due to extensive limb damage of emergent trees documented after the cyclone. Our analyses show that seasonality affected most aspects of NSL behavior, followed by the effects of Cyclone Enawo, with anthropogenic disturbances having little effect. Our data suggest that the behavioral flexibility of NSLs in response to predictable seasonality may enable them to respond similarly to stochastic climatic disturbances. However, their generalist diet may allow them to persist in anthropogenically disturbed landscapes without the need to greatly alter their behavior., (© 2021 Wiley Periodicals LLC.)

Background: Little is known about the impact of the ecosystem disruption and its contribution on the non-tuberculosis mycobacteria (NTM) diseases (cases) rate in Florida (FL), a state with a high prevalence of NTM in the United States. We aimed to evaluate the epidemiological distribution of NTM in FL and identify its association with extreme weather events., Methods: We used OneFlorida Clinical Research Consortium dataset and extracted data on NTM cases using ICD codes 9- CM 031.0 and ICD-10 A31 during 2012-2018. The number of hurricanes during the study period which affected FL were extracted data from the National Hurricane Center (NHC) and the National Oceanic and Atmospheric Administration (NOAA)., Results: Prevalence of NTM gradually increased during the study period. The rate was 2012: 14.3/100,000, 2015; 20.1/100,000 and 2018; 22.6/100,00 except in 2014 where there was an 8% decrease. The incidences were 2012; 6.5/100,00, 2015; 4.9/100,000 and in 2015; 5.4/100,000. Geographical analysis demonstrated a gradual expansion of the NTM cases in Alachua, and Marion Counties throughout the study period. Notably, the 2018 heat map showed higher prevalence of NTM in the northwestern, panhandle region of FL which had been absent in the heat maps for years 2012-2018. High number of the hurricanes was associated with the higher number of the new cases of NTM infection for years 2012, 2016-2018, while the lower number of the hurricanes was associated with the lower number of the new cases of NTM infection for years 2014-2015., Conclusion: The current study found the prevalence rates of NTM disease in FL rose from 2012 to 2018. A higher prevalence was seen following the hurricanes., (© 2021. The Author(s).)

How do natural disasters affect intimate relationships? Some research suggests that couples are brought closer together after a disaster, whereas other research suggests that relationships become more strained in the aftermath. Yet all of this work is limited by a lack of predisaster data that would allow for examination of how relationships actually change. The current study is the first to use longitudinal data collected before and after a natural disaster to examine its effect on relationship outcomes. Using a sample of 231 married couples in Harris County, Texas, who experienced Hurricane Harvey, we found that spouses experienced significant increases in satisfaction from before to after the hurricane, but the increase was temporary; couples decreased in satisfaction after the initial boost. Thus, couples appear to grow closer in the immediate aftermath of a natural disaster but then revert to their prehurricane levels of functioning as the recovery period continues.

Understanding tropical cyclone (TC) climatology is a problem of profound societal significance and deep scientific interest. The annual cycle is the biggest radiatively forced signal in TC variability, presenting a key test of our understanding and modeling of TC activity. TCs over the North Atlantic (NA) basin, which are usually called hurricanes, have a sharp peak in the annual cycle, with more than half concentrated in only 3 mo (August to October), yet existing theories of TC genesis often predict a much smoother cycle. Here we apply a framework originally developed to study TC response to climate change in which TC genesis is determined by both the number of pre-TC synoptic disturbances (TC "seeds") and the probability of TC genesis from the seeds. The combination of seeds and probability predicts a more consistent hurricane annual cycle, reproducing the compact season, as well as the abrupt increase from July to August in the NA across observations and climate models. The seeds-probability TC genesis framework also successfully captures TC annual cycles in different basins. The concise representation of the climate sensitivity of TCs from the annual cycle to climate change indicates that the framework captures the essential elements of the TC climate connection., Competing Interests: The authors declare no competing interest., (Copyright © 2021 the Author(s). Published by PNAS.)

During a disaster, pregnant women are considered among the most vulnerable., Background: On 20 September 2017, the Caribbean was hit by a category 4 hurricane. The purpose of the study was to explore the impact on pregnant women during and after the hurricane regarding access to health care, social services, and support systems., Methods: In-depth interviews were conducted to 10 women that were pregnant during the event. Qualitative inquiry based on the Interpretative Phenomenological Analysis framework was used to interpret the narratives., Results: Five major themes emerged: meaning of living through a disaster, fear, the dual burden of protecting themselves and their unborn baby, disruption in health care, and coping mechanisms. Despite the negative feelings, most participants experienced positive transformations. They narrated how they stayed calm and coped in order to protect their pregnancy. Their overall evaluation of the healthcare system was positive. The support of friends and family was crucial pre and post-disaster., Conclusions: The interviews provided a wealth of firsthand information of women experiencing a natural disaster while pregnant. The findings underscore the need to incorporate emotional support in the preparedness and response plans for pregnant women. Educating, empowering, and incorporating families and communities is vital in these efforts., Competing Interests: The authors declare no conflicts of interest.

Objectives: In the Philippines, morbidity control of soil-transmitted helminth (STH) infections is done through mass drug administration (MDA) of anthelmintics to school-age children (SAC). In 2013, the Philippines was devastated by the deadliest cyclone ever recorded, Typhoon Haiyan. The study aimed to understand the impact of Typhoon Haiyan on the MDA of anthelmintics to SAC in the provinces of Capiz and Iloilo in the Philippines from the perspectives of local health and education officials., Methods: The study was conducted in the municipalities of Panay and Pilar in Capiz and the municipalities of Estancia and Sara in Iloilo, areas that were devastated by Typhoon Haiyan. Qualitative, semi-structured key informant interviews were conducted with 16 total participants, which included officials of the Department of Health, Department of Education, and concerned local government units. All interviews were transcribed verbatim and coded in an open, iterative manner. Codes were reviewed to identify patterns and themes., Results: Participants described the following themes: (1) their perception that the typhoon had no effect on the MDA program or on resources necessary to complete the program; (2) the program's simple design allowed for 1-time administration to a pre-assembled population; (3) the program allowed a sense of community cohesiveness; (4) the program served as a vehicle for altruism, particularly regarding helping needy children, in this time of calamity., Conclusions: Our informants perceived that the MDA program in Region VI was not affected by Typhoon Haiyan. They attributed the resilience to the program's simple procedure, attitudes of altruism, program importance, and community cohesiveness. Despite Typhoon Haiyan's mass destruction of infrastructure and livelihood leading to incredible challenges, mobilization of the community allowed for the continuation and successful implementation of the MDA program. The experience of Region VI may serve as a model for other low- and middle-income countries prone to natural disasters.

In hazard and disaster contexts, human-centered approaches are promising for interdisciplinary research since humans and communities feature prominently in many definitions of disaster and the built environment is designed and constructed by humans to serve their needs. With a human-centered approach, the decision-making agent becomes a critical consideration. This article discusses and illustrates the need for alignment of decision-making agents, time, and space for interdisciplinary research on hurricanes, particularly evacuation and the immediate aftermath. We specifically consider the fields of sociobehavioral science, transportation engineering, power systems engineering, and decision support systems in this context. These disciplines have historically adopted different decision-making agents, ranging from individuals to households to utilities and government agencies. The fields largely converged to the local level for studies' spatial scales, with some extensions based on the physical construction and operation of some systems. Greater discrepancy across the fields is found in the frequency of data collection, which ranges from one time (e.g., surveys) to continuous monitoring systems (e.g., sensors). Resolving these differences is important for the success of interdisciplinary teams in protective-action-related disaster research., (© 2019 Society for Risk Analysis.)

Introduction: On September 20, 2017, Hurricane Maria, a Category 4 hurricane, swept across Puerto Rico (PR), wreaking devastation to PR's power, water, and health care infrastructure. To address the imminent humanitarian crisis, the US government mobilized Federal Medical Shelters (FMS) to serve the needs of hurricane victims. This study's objective was to provide a description of the patients seeking emergency care at FMS and the changes in their needs over time., Methods: This retrospective, cross-sectional study included all patients presenting to the FMS Manatí from October 6, two weeks after Hurricane Maria's landfall, to November 2, 2017. Categories were created to catalogue the nature of new acute medical issues by patients presenting to the Shelter. Descriptive, graphical analyses were performed to assess changes to presenting complaints over time, and by age groups defined as infant (age ≤1 years), child (1 year < age ≤10 years), adolescent (10 years < age ≤ 25 years), and adult (age > 25 years)., Results: Over the 30-day period, 5,268 patients were seen in the FMS seeking medical care (average 188.1 patients per day), spending less than five hours in the facility. The distribution of patients' age was bimodal: the first peak at one year and the second at age 50. The most common patient complaint was infection (38.8%), then musculoskeletal (MSK) complaints (11.8%) and management of chronic medical conditions (11.8%). The proportion of patients presenting with chronic disease complaints declined over the course of the period of observation (21.4% on Day 4 to 8.0% on Day 30) while the proportion of patients presenting with infection increased (31.0% on Day 4 to 48.6% on Day 30). Infection complaints were highest in all age groups, but most in infxants (80.2%), while MSK and chronic disease complaints were highest in adults (14.9% and 14.9%, respectively)., Conclusion: Infection treatment and chronic disease management were important medical needs facing patients seeking care at FMS Manatí after Hurricane Maria. These findings suggest that basic needs related to sanitation and shelter remained important weeks after the hurricane, and a focus on access to medications, infection control, and injury prevention/management after a disaster needs to be prioritized during disaster response.